Prior Authorization Specialist

Upland Hills Health; Mount Horeb (WI); On-site; USD 25,000 - 39,000; Part time

Job summary

Upland Hills Health in Mount Horeb, WI seeks a Part-time Prior Authorization Specialist to manage precertifications and insurance authorizations for scheduled services in the Family Practice Clinics. Training may occur at multiple locations, with 0.8 FTE hours, Monday–Friday, 8:30 a.m.–5:00 p.m.

The role requires at least a two-year degree and two years of healthcare or insurance experience, strong communication, and attention to detail. Epic experience is preferred.

Qualifications

• Two year or greater educational degree preferred.
• Minimum of two years healthcare or insurance experience is required.
• Knowledge of medical terminology is required.
• Excellent communication and organizational skills are required.
• Attention to detail and accuracy are required.
• Ability to handle multiple priorities and prioritize as needed.
• Previous experience with interpreting physician orders and notes is preferred.
• Previous experience with CPT codes and ICD-10 diagnosis codes is preferred.
• Previous experience with Epic is preferred.
• Previous experience with Microsoft Office Applications programs is beneficial.

Responsibilities

• This position is responsible for obtaining precertification, authorizations and insurance benefits for scheduled services to ensure insurance payments.
• Obtains patient’s insurance benefit information with the insurance company.
• Notifies insurance company in a timely manner of scheduled patients in preparation of hospital outpatient services.
• Obtains missing medical and insurance information from a variety of sources to enable authorizations to be completed.
• Documents case status, actions and outcome in the authorization database.
• Clearly documents authorization information in Epic.
• Communicates with clinical staff as needed.
• Communicates any updates to patient demographics or insurance coverage to the Business Office.
• Assists in training and development of new personnel.
• Can easily manage multiple authorization requests at once.
• Performs other duties as assigned.

Skills

Excellent communication

Organizational skills

Attention to detail

Ability to manage multiple priorities

Medical terminology

Training staff

Interpreting physician orders

Education

Two year or greater educational degree preferred

Tools

Epic

Microsoft Office Applications

Job description

Position: Prior Authorization Specialist

Location: Mt. Horeb, WI

Job Id: 856

# of Openings: 1

Position Title: Prior Authorization Specialist

Location: Upland Hills Health - Mount Horeb and Barneveld Clinics (During training other locations may be requested)

Role & Department: Prior Authorization Specialist in the Family Practice Clinics

Hours & Shift: Part-time (.8 FTE) day shift position, Monday through Friday 8:30 a.m. to 5:00 p.m., 4 days/week.

Role Responsibilities:

• This position is responsible for obtaining precertification, authorizations and insurance benefits for scheduled services to ensure insurance payments
• Obtains patient’s insurance benefit information with the insurance company
• Notifies insurance company in a timely manner of scheduled patients in preparation of hospital outpatient services
• Obtains missing medical and insurance information from a variety of sources to enable authorizations to be completed
• Documents case status, actions and outcome in the authorization database
• Clearly documents authorization information in Epic
• Communicates with clinical staff as needed
• Communicates any updates to patient demographics or insurance coverage to the Business Office
• Assists in training and development of new personnel
• Can easily manage multiple authorization requests at once
• Performs other duties as assigned

Qualifications:

• Two year or greater educational degree preferred
• Minimum of two years healthcare or insurance experience is required
• Knowledge of medical terminology is required
• Excellent communication and organizational skills are required
• Attention to detail and accuracy are required
• Ability to handle multiple priorities and prioritize as needed
• Previous experience with interpreting physician orders and notes is preferred
• Previous experience with CPT codes and ICD-10 diagnosis codes is preferred
• Previous experience with Epic is preferred
• Previous experience with the Microsoft Office Applications programs is beneficial

Employee Benefits:

Comprehensive benefits packages available for both part and full-time employees!

Paid Time Off (PTO) benefits begin to accrue on day one!

Retirement Plan with matching dollars available!

Two wellness center facilities that employees are eligible to use free of charge & a minimal fee for spouses!

Many Employer Sponsored Events held throughout the year to celebrate our employees!

Why Upland Hills Health:

Upland Hills Health (UHH) consistently ranks as a very high performing health care institution in Southwestern Wisconsin. Located just 40 minutes from Madison, WI and as well from Dubuque, IA, the area is surrounded by wonderful communities and beautiful scenery. For over 100 years, Upland Hills Health has been dedicated to the promise of offering the highest standard of healthcare. Our community-minded staff emphasizes providing quality, comprehensive healthcare while offering a comfortable, neighborly welcome to everyone who walks through our doors. Here, neighbors care for neighbors!